Provider Demographics
NPI:1003574310
Name:BRAYLOCK, ROBERT EUGENE (PHARMD, RPH, MBA)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EUGENE
Last Name:BRAYLOCK
Suffix:
Gender:M
Credentials:PHARMD, RPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6809 MAYFIELD RD APT N752
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2273
Mailing Address - Country:US
Mailing Address - Phone:216-212-7696
Mailing Address - Fax:
Practice Address - Street 1:2720 HIGHWAY 42 N
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-4301
Practice Address - Country:US
Practice Address - Phone:770-898-7356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03136052183500000X
GA033370183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist